Immense progress in the treatment of shoulder joint problems has been made in recent years. This is mainly due to the introduction of endoscopic operative techniques, in which an opening of the joint is no longer necessary. In addition, developments have occurred in the areas of precise instruments, a new type of suture material, and bone fixation systems.
Just as in operations on the knee and elbow joints, the shoulder joint can be operated on through tiny skin incisions without major trauma and with little pain. Using a thin lighted optical instrument (arthroscope), the interior of the joint can be completely visualized. Painful shoulders, limitations of shoulder movement, shoulder instability, calcification, and small tears in the rotator cuff can best be handled with this operating technique. Pains after arthroscopic procedures are much less, and the joint can be moved and bear weight much earlier than previously. Scars are barely visible. Most operations are done on an outpatient or day hospital basis.
Freedom of movement of the arm and the hand is based primarily on the extensive mobility of the shoulder joint, a joint that is made up of the large head of the upper arm (humeral head) and the relatively small joint socket (glenoid cavity). The complicated interplay of tendons, muscles, and joint capsule is necessary for the perfect functioning of the shoulder. In addition, the shoulder joint connects the collarbone (clavicle) with the shoulder blade (scapula). The joint capsule with the joint tendons is attached at the bony edge of the glenoid cavity to an elastic ring, which is called the labrum. This labrum-capsule setup is very important for the stability of the shoulder. The structures are damaged if there are luxations of the shoulder.
One muscle group, called the rotator cuff, divides the actual shoulder joint from a sliding area (subacromial space) that is found under the bony cover of the shoulder. The rotator cuff is responsible principally for "centering" the humeral head, the sideways lifting of the arm, and for rotational movements. A bursa is found between the shoulder roof and this muscle group, which facilitates the "sliding in" of the rotator cuff underneath the bony shoulder roof.
Shoulder pain results from tears in the rotator cuff, degeneration of the tendons, bony changes in the shoulder roof, degeneration of the shoulder corner joint (acromioclavicular joint), and calcifications in one of the tendons of the rotator cuff, resulting in inflammation of the bursa. The cause can be reliably discovered through careful examination, supported by imaging procedures such as x-rays, ultrasound examinations, and MRI examinations.